The Royal College of Podiatry's response to the UK government's consultation on reforming the General Medical Council legislative framework

This consultation sought views on the draft General Medical Council Order 2026, which would reform how the General Medical Council (GMC) regulates medical practitioners, physician associates and anaesthesia associates across the UK.

It also sought views on:

implementing Leng Review recommendations 1 and 9 relating to proposed changes to professional titles to improve clarity for patients
regulatory reform recommendations made by Lord Mann in his rapid review into antisemitism and other forms of racism in healthcare

The consultation opened on 24 March 2026 and closed on 21 July 2026.

See Reforming the General Medical Council legislative framework

The College's response

The College's response corresponds to the questions found here.

1. Commencement

We need to ensure that the commencement of the General Medical Council Order 2026 is managed in a safe and effective way that mitigates the risks of a regulatory gap during this transition. 

A ‘coming into force date’ mechanism has been included for parts 2 to 10 of the draft order. However, we have not specified a date for when parts 2 to 10 come into force as per article 2(2)(b) of the draft order. Article 2(2)(b) relates to the coming into force of the majority of the provisions within the draft order.

Although a coming into force date for the General Medical Council Order 2026 would provide clarity, there would be advantages in allowing flexibility regarding when provisions are activated, in particular for areas involving transition of cases from the old framework to the new. This could be achieved by specifying dates in tertiary legislation – for example, to be made through a Privy Council Order.

Do you agree or disagree that a specific ‘coming into force’ date should be included in article 2(2)(b) of the final General Medical Council Order 2026? (Optional)

Disagree with a fixed ‘coming into force’ date.

Please explain your answer. (Optional)

The Royal College of Podiatry (RCPod) recommends retaining flexibility in the commencement of the Order.

If you have any further comments regarding the commencement of the General Medical Council Order 2026 and the transition to GMC's new legislation, please set them out here. (Optional)

As both a professional body and a trade union, we place significant emphasis on safe system transition, particularly where regulatory change intersects with workforce deployment and public safety.

A fixed implementation date could:

Create transitional risks, particularly if parallel regulatory systems operate simultaneously

Lead to inconsistencies in fitness to practise processes, which may disadvantage registrants

Impact multidisciplinary teams, including podiatrists, where scope and accountability must remain clear.

We therefore support a phased or staged approach via secondary legislation, ensuring continuity of regulation, safe transfer of cases, and clarity for the public and registrants alike.

2. Governance

Separate to annual report requirements relating to equality and diversity, the draft order contains the following for GMC relating to equality, diversity and inclusion:

a duty to ensure that, in the exercise of its functions, it applies good practice in relation to equality and diversity

where it considers that an improvement may be required, a duty to take such steps as it considers appropriate to make that improvement

a duty to have regard to any current or future principles set by the Professional Standards Authority for Health and Social Care regarding equality, diversity and inclusion

Do you agree or disagree with the inclusion of these requirements in the order? (Optional)

Agree.

Please explain your answer. (Optional)

We support the strengthened duties on equality, diversity and inclusion.

However, we emphasise that: EDI must extend beyond regulator governance into professional standards, training pathways, and workforce access. Regulatory frameworks must avoid unintended professional hierarchies, particularly in multidisciplinary care.

Parts 2 to 4 of the draft order relate to GMC's governance and operating functions. This includes provisions relating to delegation of exercise of functions, disclosure of information, guidance, annual reports, fee setting and other financial requirements, and default powers of the Privy Council.

The provisions in these sections aim to improve the efficiency of GMC's administrative functions, reducing bureaucracy.

Do you agree or disagree that the provisions set out in parts 2 to 4 of the draft order enable GMC to carry out its governance and operating framework functions appropriately? (Optional)

Broadly agree, with caveats.

Please explain your answer. (Optional)

We support improved efficiency but note: Reduced oversight must not compromise accountability or confidence in regulatory decisions. There must be transparency in fee-setting, particularly given cost pressures affecting registrants across the system

Schedule 1 to the draft order includes provisions to enable GMC and the Medical Tribunal Service to effectively operate. It outlines how the GMC board may operate under the order, how committees may function and how adjudicatory bodies such as appeal panels may operate. It also puts a duty on GMC to appoint a registrar and case examiner or case examiners to exercise certain functions on behalf of GMC. In addition, the Privy Council must, by order, make further provision as to the constitution of the regulator.

Do you agree or disagree that the powers and duties in schedule 1 on constitution of the regulator are sufficient to enable GMC and the Medical Tribunal Service to carry out their functions appropriately and proportionately? (Optional)

Agree, with caveats.

Please explain your answer. (Optional)

We support flexibility in governance structures, provided: There is clear separation between investigation, adjudication, and appeals. Decision making remains independent and evidence based.

The draft order proposes that the Privy Council's default powers continue to apply (they are currently contained in section 50 of the Medical Act 1983). These are powers which the Privy Council may use if it feels that GMC has failed to carry out its regulatory functions. In relation to GMC’s rule-making powers in the draft order, the Privy Council will no longer be required to approve new rules or rule changes made by GMC under the draft order. However, should any future rules be deemed to require Privy Council approval, such approval will be put in place.

Do you agree or disagree that the powers and duties in the draft order in relation to the Privy Council are sufficient to support GMC to carry out its functions appropriately? (Optional)

Agree in principle.

Please explain your answer. (Optional)

We support retention of default powers as a safeguard but emphasise that reduced oversight of rulemaking must not lead to regulatory drift or inconsistency.

3. Professional Standards Authority for Health and Social Care evidence gathering

The draft order, as per a recommendation of the Mann Review, provides for a consequential amendment to be made to the National Health Service Reform and Health Care Professions Act 2002 to allow the Professional Standards Authority for Health and Social Care to have a power to compel information from GMC.

Do you agree or disagree that the draft order provides the Professional Standards Authority for Health and Social Care with sufficient and proportionate evidence-gathering powers? (Optional)

Agree.

Please explain your answer. (Optional)

We support proportionate powers for the Professional Standards Authority (PSA). From our experience as a body representing regulated professionals subject to fitness to practise, effective oversight strengthens public confidence and ensures consistency across regulators.

4. Education and training

The draft order sets out that GMC can approve overseas undergraduate, foundation and postgraduate education and training programmes.

Do you agree or disagree that GMC should be able to approve overseas undergraduate, foundation and postgraduate education and training programmes? (Optional)

Agree, with caution.

This does not mean that people who take part in such overseas programmes would be given priority for places on the UK foundation programme or for speciality training in the UK, subject to a few limited exceptions in the Medical Training (Prioritisation) Act 2026.

Please explain your answer. (Optional)

We support this flexibility, provided standards are equivalent to UK programmes, and there is no dilution of professional competence thresholds.

Part 5 of the draft order relates to GMC's education and training functions. This includes provisions relating to:

standards in connection with practising as a regulated professional

approval of education and training, an examination or assessment or a qualification

supply and production of information and evidence

criminal offences

certification of completion of a course

other related powers.

Our proposed changes aim to enable GMC to undertake more flexible and swifter education and training functions.

Do you agree or disagree that the powers and duties set out in the draft order enable GMC to carry out its education and training functions sufficiently and proportionately? (Optional)

Agree.

Please explain your answer. (Optional)

Regulatory bodies must ensure that expanded and advanced roles are underpinned by formal, accredited education. This is particularly important given current system pressures and the expansion of advanced practice roles.

Recent debate, including statements from the BMA, has highlighted concerns regarding role substitution and the variability in how advanced practice is defined and deployed. Across the allied health professions, it is well established that advanced practice is a distinct level of practice rather than a job title, characterised by a defined scope, high levels of autonomy, and accountability, and underpinned by Masters level education, accredited training pathways, and robust governance frameworks.

We strongly emphasise that advanced practitioners must operate within clearly defined scopes of practice, supported by appropriate regulation, professional standards, and organisational oversight. This ensures patient safety, service quality, and workforce sustainability.

Crucially, patients and the public must be able to understand and distinguish between regulated healthcare professionals working at an advanced level and other emerging roles, with clarity on qualifications, accountability, and professional standards.

5. Postgraduate Medical Education and Training Order of Council 2010

As a consequence of modernising GMC’s register and legislative framework, many of the current provisions contained within the Postgraduate Medical Education and Training Order of Council 2010 ('the PMET Order') will become obsolete.

The draft order therefore proposes that the PMET Order is revoked, including the list of recognised specialties currently contained in the schedule to the PMET Order, and the Privy Council is given a power to specify categories of speciality in practice in the UK in an order of council.

Do you agree or disagree that the PMET Order should be revoked and the categories of speciality in practice should be set out in a new order of council? (Optional)

Agree.

Please explain your answer. (Optional)

We support modernisation, provided the process for defining specialties remains transparent and independently governed.

6. Registration

The draft order provides that medical practitioners may be able to be registered despite having a complete restriction on registration. This means they will be registered as a medical practitioner but not allowed to practise. A medical practitioner may choose to have a complete restriction on their registration, or a complete restriction could be, for example, the result of failing to complete periodic assessment.

Do you agree or disagree that doctors should be able to be registered with a complete restriction on registration? (Optional)

Agree.

Please explain your answer. (Optional)

This provides transparency about professional status, and a mechanism for maintaining registration where appropriate. However, clear communication to the public is essential to avoid misunderstanding of professional competence.

Part 6 of the draft order relates to registration and includes provisions regarding the process of entering the register. It also includes provisions which enable GMC to provide assurance that individuals on its register have the necessary education, training, knowledge, skills and experience required to practise safely in the UK.

Do you agree or disagree that the draft order enables GMC to carry out its functions relating to registration sufficiently? (Optional)

Agree.

Please explain your answer. (Optional)

We support the emphasis on assurance of competence, qualification, and experience. This aligns with our expectation for all regulated professions, including podiatry.

7. Protection of title

Protected title status means it is a criminal offence for someone to practise and use a protected title without being registered with the relevant regulator and on the relevant register, or part of the register, relating to that regulated profession. 

The draft order proposes that the titles of 'apothecary' and 'licentiate in medicine and surgery' should no longer be protected in legislation as they are not reflective of current practice. It also proposes that the title of 'bachelor of medicine' should no longer be protected as this is linked to a qualification rather than a professional title.

Do you agree or disagree that the titles of 'apothecary', 'licentiate in medicine and surgery' and 'bachelor of medicine' should no longer be protected in legislation? (Optional)

Agree.

Please explain your answer. (Optional)

We agree that these titles should no longer be protected, as they do not reflect contemporary medical practice and may contribute to confusion for patients and the public. Removing outdated or qualification-based titles from protection supports greater clarity around current professional roles and aligns protection more appropriately with modern, regulated professional practice.

Do you agree or disagree that 'registered medical practitioner' should become a protected title? (Optional)

Agree.

Please explain your answer. (Optional)

We agree that ‘registered medical practitioner’ should be a protected title, as it provides clear, accessible assurance to patients about professional status, regulatory oversight, and accountability.

Do you agree or disagree that the title of 'physician associate' should be changed to 'physician assistant' and protected in law? (Optional)

Disagree.

Please explain your answer. (Optional)

The Royal College of Podiatry has significant concerns about these proposals. Specifically, the shift to ‘assistant’ terminology may increase confusion, not reduce it. There is a risk of blurring professional boundaries. Our broader concern is that across NHS services, there is increasing expansion of roles that are not subject to equivalent regulatory oversight, and do not undergo fitness to practise processes comparable to established professions.

Do you agree or disagree that the title of 'anaesthesia associate' should be changed to 'physician assistant in anaesthesia' and protected in law? (Optional)

Disagree.

Please explain your answer. (Optional)

To allow time for the healthcare service to implement the new titles effectively, we are proposing that the protection of the 'physician assistant' and 'physician assistant in anaesthesia' titles will commence following a transition period of 6 months after the order comes into force, if approved by Parliament.

Do you agree or disagree that there should be a transition period in relation to moving from the associate titles to the assistant titles? (Optional)

Agree (pragmatically).

Please explain your answer. (Optional)

A transition period is necessary but does not address the underlying policy concerns.

Should there be any protection of the 'physician associate' and 'anaesthesia associate' titles alongside the proposed new titles? (Optional)

Disagree.

Please explain your answer. (Optional)

We do not support protecting both the existing and proposed titles concurrently, as this would increase confusion rather than improve clarity for patients and the public. Maintaining multiple protected titles for similar roles risks blurring professional boundaries and undermining clear accountability within multidisciplinary teams.

As a professional body and trade union representing HCPC regulated clinicians subject to fitness to practise, we consider clear and consistent professional titles essential for patient safety. If changes proceed, there should be a single, clearly defined, and properly regulated title, supported by consistent standards. Retaining overlapping titles would weaken public understanding of who is responsible for care at a time of growing concern about the expansion of non-medical and advanced roles.

We recognise the importance of clear and appropriately protected professional titles. However, any revisions must be carefully designed to avoid exacerbating existing confusion among both the public and professionals. Current uncertainty surrounding roles, scope of practice, and professional identity, particularly in relation to physician associates, demonstrates that greater standardisation and clarity across the system should be prioritised. Without this, changes to titles risk compounding, rather than resolving, issues of understanding, accountability, and patient confidence.

8. Fitness to practise - mandatory removal from the register

The draft order requires GMC to mandatorily remove a registrant from its register, if the registrant has been convicted of a serious criminal offence, as set out in schedule 4 (known as a listed offence), without GMC having to investigate or the Medical Tribunal Service having to hold a fitness to practise panel hearing to determine whether the registrant’s fitness to practise is impaired.

Do you agree or disagree with the listed offences set out in schedule 4 of the draft order? (Optional)

Agree in principle.

Please explain your answer. (Optional)

We support strong action for serious offences. However, removal without full investigation must be applied proportionately. Safeguards must ensure procedural fairness, and protection against erroneous convictions.

We would also welcome further clarity on how the GMC would consider applicants who have previously been removed from other professional regulators’ registers. It is important that consistent and robust safeguards are in place across the regulatory system. In particular, clarification is needed on whether reciprocal mechanisms exist to ensure that individuals removed from the GMC register cannot re-enter patient facing roles through alternative professional routes without appropriate scrutiny. Strengthening alignment between regulators in this area would support public protection and maintain confidence in regulatory processes.

Under the draft order, former registrants of GMC who have been mandatorily removed from the register following conviction for a listed offence in schedule 4 of the draft order will not be able to apply for re-entry to the register.

Exceptions would apply where the conviction has been quashed or was for a lower-level listed offence (blackmail or extortion), and the custodial sentence has been quashed and replaced with a non-custodial sentence.

Do you agree or disagree that former registrants who have been mandatorily removed from the register following conviction for a listed offence should not be able to apply for re-entry to the register, save for in the limited exceptional circumstances prescribed in the draft order? (Optional)

Agree.

Please explain your answer. (Optional)

We support the principle that registrants removed following conviction for serious listed offences should not be eligible for re-entry, other than in very limited and clearly defined exceptional circumstances. This reflects the need to maintain public confidence in professional regulation and uphold the highest standards of trust and patient safety.

However, it is essential that any exceptions are narrowly drawn, transparently applied, and supported by robust safeguards to ensure fairness and proportionality, particularly in cases where convictions are overturned or materially altered.

9. Fitness to practise - grounds for action

Grounds for action set out the basis on which regulators can investigate and take action where there is a concern about a regulated healthcare professional’s fitness to practise. A regulated professional’s fitness to practise can only be found to be impaired if one or more of the grounds for action are met. 

The draft order proposes that the fitness to practise of a regulated professional may be impaired if the regulated professional:

is unable to provide care to a sufficient standard

has behaved in a way which amounts to misconduct

is adversely affected by a physical or mental health condition

Do you agree or disagree with the grounds for action set out in the draft order? (Optional)

Agree.

Please explain your answer. (Optional)

The proposed grounds are consistent with existing regulatory frameworks across health professions.

10. Fitness to practise – proceedings

Fitness to practise proceedings are one of the primary ways by which GMC ensures public protection. The fitness to practise model outlined in the draft order aims to make fitness to practise proceedings swifter, fairer and less adversarial for GMC's registrants and people who raise concerns.

Do you agree or disagree that the fitness to practise powers and duties set out in the draft order for GMC and the Medical Tribunal Service are sufficient and proportionate for the safe and effective regulation of the professions GMC regulates? (Optional)

Agree.

Please explain your answer. (Optional)

We support a less adversarial system and improved timeliness. However, fairness and independence must remain central, and registrants must have access to appropriate representation (consistent with our role as a trade union).

11. Interim registration measures

Under the draft order, a fitness to practise panel’s powers will be extended so that the panel can impose interim registration measures during registration proceedings, as well as during fitness to practise proceedings. 

This would allow the panel to impose an interim registration measure while investigating whether a register entry is fraudulent, for example.

Do you agree or disagree that a fitness to practise panel’s power should be extended so that it can impose an interim registration measure during registration proceedings as well as fitness to practise proceedings? (Optional)

Agree.

Please explain your answer. (Optional)

This is a proportionate extension of powers, particularly in cases involving potential fraud or public safety risk.

12. Evidence gathering

Under the draft order, GMC may, for the purpose of gathering evidence in connection with registration, fitness to practise and interim registration measure proceedings, require a person to supply such information or produce such a document as GMC may specify. GMC will also be able to require a witness to attend a fitness to practise panel hearing or an appeal panel hearing.

Do you agree or disagree that the draft order provides GMC with sufficient and proportionate evidence-gathering powers? (Optional)

Agree with safeguards.

Please explain your answer. (Optional)

Stronger powers are appropriate but must be proportionate and avoid undue burden on registrants.

13. Rule-making powers

Under the draft order, GMC is able to make rules on specific procedures in relation to:

governance and operating framework

education and training

registration

fitness to practise

interim registration measures

revision of decisions and internal appeals

Do you agree or disagree that the rule-making powers in the draft order are sufficient and proportionate for the regulation of the professions GMC regulates? (Optional)

Agree with caution.

Please explain your answer. (Optional)

Flexibility is welcome, but meaningful consultation and transparency are essential to maintain trust.

14. Revision of decisions

Under the draft order, GMC will be able to revise specific:

registration decisions (except emergency registration decisions)

fitness to practise decisions (except fitness to practise panel decisions)

case examiner interim registration measure review decisions

Do you agree or disagree that the draft order provides GMC with sufficient and proportionate powers and duties in relation to revision of decisions? (Optional)

Agree.

Please explain your answer. (Optional)

Internal review mechanisms support efficiency, provided decision-making remains transparent and independent.

15. Appeals

Under the draft order, applicants for registration, registrants and former registrants of GMC will have rights of appeal against specific registration and fitness to practise decisions.

Do you agree or disagree that the powers in the draft order provide individuals with sufficient and proportionate appeal rights? (Optional)

Agree.

Please explain your answer. (Optional)

We agree that the draft order provides broadly sufficient and proportionate appeal rights for applicants, registrants, and former registrants. Robust rights of appeal are essential to ensure fairness, maintain confidence in regulatory processes, and support just outcomes in both registration and fitness to practise decisions.

Under the draft order, as per a recommendation of the Mann Review, GMC will have a right of appeal against specific interim registration measure decisions and fitness to practise decisions made by a fitness to practise panel to the:

High Court of Justice in England and Wales

Court of Session in Scotland

High Court in Northern Ireland

Do you agree or disagree that GMC should have a right of appeal to these courts against specific interim registration measure and fitness to practise decisions made by a fitness to practise panel? (Optional)

Agree.

Please explain your answer. (Optional)

We support the GMC having a right of appeal to the courts in defined circumstances, as this provides an important safeguard where there may be concerns about the outcome of fitness to practise or interim measures decisions. This helps ensure consistency, public protection, and confidence in fitness to practise outcomes.

Under the draft order, a consequential amendment will be made to the National Health Service Reform and Health Care Professions Act 2002 to allow the Professional Standards Authority for Health and Social Care to appeal specific fitness to practise and interim registration measure decisions made by a fitness to practise panel to the:

High Court of Justice in England and Wales

Court of Session in Scotland

High Court in Northern Ireland

Do you agree or disagree that the Professional Standards Authority for Health and Social Care should be able to appeal specific fitness to practise decisions and interim registration measure decisions made by a fitness to practise panel to these courts? (Optional)

Agree.

Please explain your answer. (Optional)

We support the PSA having the ability to appeal decisions, as this strengthens independent oversight across the regulatory system. This is particularly important in maintaining consistency between regulators and reinforcing public confidence in the regulatory system.

Under the draft order, GMC will be permitted to administer its own internal appeals function. Applicants for registration, registrants and former registrants will be able to appeal specific registration and fitness to practise decisions to an appeal panel of GMC.

Do you agree or disagree that the draft order provides GMC with sufficient and proportionate powers and duties to administer its appeals function? (Optional)

Agree with safeguards.

Please explain your answer. (Optional)

We support the introduction of an internal appeals function as a means of improving efficiency and timeliness. However, it is essential that these processes are clearly independent of original decision making, transparent, and underpinned by robust safeguards to maintain fairness and avoid perceived or actual conflicts of interest.

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